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Getting dogs back on their paws

Editor's Note: Darryl Millis, DVM, is a professor of orthopedic surgery and the director of surgical services in the Department of Small Animal Clinical Sciences at the University of Tennessee in Knoxville. He is a Diplomate of the American College of Veterinary Surgeons, a Diplomate of the American College of Sports Medicine and Rehabilitation and a Certified Canine Rehabilitation Practitioner. Millis is the co-editor of the textbooks Essential Facts of Physiotherapy in Dogs and Cats; Multimodal Management of Osteoarthritis; and Textbook of Small Animal Physical Therapy and Rehabilitation.

DVM: You've said in years past that the veterinary field doesn't pay enough attention to physical rehabilitation practices. Why do you think that is?

Dr. Darryl Millis

Millis: Actually, it was overlooked, but that's turning around now. There's much more interest in the topic—in fact, I'd call it a groundswell of support. More people are going to canine rehab meetings, and there are more rehab short course offerings in the field.

We started this call for rehab at a meeting of the American College of Veterinary Surgeons in 1999. I thought it would be a tough crowd to sell. I was prepared to be peppered with criticism. But there was so much positive feedback that I realized veterinarians were ready for rehab medicine.

DVM: To what do you attribute the increased interest?

Millis: I think more people are identifying the value of a multimodal treatment approach to conditions such as osteoarthritis in dogs. Ten years ago, veterinarians treated arthritis with medication alone, but now there's more widespread recognition of the value of physical rehabilitation and other nonpharmacologic treatment options.

DVM: What would you like to see changed in veterinary training as it relates to rehabilitation medicine?

Millis: It would be helpful to have elective courses, or even part of a required course, in veterinary college curricula that focus on basic rehab techniques. Here at the University of Tennessee, all of our senior-year students on clinical rotation spend some time in physical rehabilitation.

DVM: Which type of patients and conditions are best treated with rehab?

Millis: Dogs with cranial cruciate ligament rupture have been shown to improve with postoperative rehab designed to help them strengthen the tissues surrounding the joint and improve limb use during recovery.

Also, for dogs with neurologic disorders such as disk ruptures or degenerative myelopathy, rehabilitation can be an important part of the treatment plan. People realize that, even for themselves, some postsurgical rehab can enhance recovery, and I think we're making the connection that if it helps us, it can help dogs, too.

One in five dogs has arthritis. They could greatly benefit from rehab techniques, such as slow leash walking, maybe a little jogging, some swimming and other aquatic therapies. Certain physical modalities can also be beneficial in the treatment of arthritis.

Patients with fractures around and in joints also have improved function with rehab. Almost any neuromusculoskeletal disorder can benefit from rehab.

DVM: Are there any cases in which rehab is inappropriate?

Millis: There has been some discussion of trying to manage cruciate ruptures with rehab only, no surgery. Sometimes that may result in some improvement, but it's really appropriate only for patients for whom surgery would be life-threatening, for example, a dog with a severe cardiac condition that cannot tolerate anesthesia. Those cases could be managed with rehab alone. But veterinarians should be aware that weight-bearing exercises on an unstable stifle joint hasten the progression of arthritis.

That said, nearly every patient with a cruciate rupture could benefit from surgery first to stabilize the joint, and then undergo postoperative rehab.

There are also some dogs that don't allow a therapist to perform treatments or dogs that have severe anxiety. Although we try to work with these patients to make rehabilitation a pleasant experience, if it's too stressful or the dog doesn't tolerate treatment, then we may discontinue rehabilitation in the clinical environment and have the owners do some form of treatment at home.